Fracture - Specifically in the Metacarpals

A fracture that extends into the joint at the transition between the metacarpal bone and the wrist has two notorious complications: 1) the joint is no longer in place, and 2) the joint is damaged. Tendons and the joint capsule pull the broken bone fragments apart, displacing the joint.
Due to the mobility, shape, and relatively high load of this area, any misalignment carries a significant risk of early wear and tear and requires specialist attention. Inadequate treatment increases the chance of a painful, unstable, and/or stiff joint.

Causes of a fractured thumb metacarpal

The most common cause is a direct impact along the axis of the thumb.
This often occurs from a punch or a fall onto the thumb — for example, in cyclists, moped riders, or while holding objects during impact.

Symptoms of a fractured thumb metacarpal

Swelling and pain at the base of the thumb, along with the thumb being slightly shifted toward the palm, are signs of a fracture. Grip strength may also be reduced, and the base of the thumb may feel unstable. Clear X-rays are needed to assess both the displacement and the fracture in the joint itself. Two common types of fractures are the Bennett fracture and the Rolando fracture. A Bennett fracture is a diagonal break on the pinky side of the thumb base. In a Rolando fracture, the base of the metacarpal is broken on both sides, causing the entire metacarpal to collapse.
In some cases, a CT scan is required for further assessment.

Treatment of a fractured thumb metacarpal

If only a small fragment is broken off and the joint is displaced by no more than 1 millimetre, casting is sufficient and surgery is not needed. If the displacement is more than 1 millimetre, surgery will be required. Due to the unique shape of the joint, a metal pin is often used to temporarily stabilize the bone. From 3 millimetres of displacement, the fracture is considered unstable, and screws are typically used.

Aftercare for a fractured thumb metacarpal

It can take 4 to 6 weeks for the fracture to heal. During this time, the bone needs rest. In many cases, a hand therapist is involved afterward, or one of our thumb braces from Podobrace is recommended to support recovery.